The Republicans Own Obamacare Now. How Many People
Will They Let Suffer?

The expanded health-care coverage created by the Affordable Care Act has been in place for just three years, and already its effects are measurable. Hospital-acquired conditions have dropped by 21 percent, saving more than 125,000 lives, in response to better incentives. (Before Obamacare, if hospitals had lots of infections, affected patients would return for more treatment, increasing hospital revenue.) Diagnoses of certain chronic conditions among low-income patients have risen. Access to routine checkups has increased, and people are now in less danger of falling into debt because of illness. Medical inflation has dropped to its lowest level in decades.

As Donald Trump’s Republican-controlled government assumes power, it has made its first task the dismantling of the law that has produced these gains. If we were watching a developing country consciously set about reversing its own social progress — shutting down its electrical grid, tearing out its indoor-plumbing system to revert to well water — we would find it baffling. The extent of the damage Republicans inflict remains to be seen, but one way to calculate it, should the dismantling occur, will be in American lives lost. The Congressional Budget Office has estimated that 18 million Americans would immediately lose their insurance, a number that would increase to 32 million by 2026. A study of mortality rates in Massachusetts before and after that state enacted reforms similar to Obamacare found that one life was saved for every 830 adults who gained insurance coverage. Eighteen million divided by 830 equals almost 22,000 lives at stake, plus untold suffering from millions who would be denied access to regular medical care. The fact that Republicans are embarking on such a cruel, self-destructive project at all speaks to the pathology that has engulfed the new governing party.

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Trump has insisted throughout the campaign that he will “take care of everybody,” that his plan would be “much less expensive and much better” and is “very much formulated down to the final strokes. We haven’t put it in quite yet, but we’re going to be doing it soon.” This boast created some initial confusion within party ranks; Republican health-care adviser Yuval Levin reported that “the conservative health-care universe, including some people on Trump’s own team, quickly concluded that the separate administration plan he described was entirely a figment of Trump’s imagination.” Trump is employing the same technique he used to enthrall conservatives about the birther conspiracy, only in reverse: Rather than pretending that a real document (Barack Obama’s birth certificate) was fake, he insisted an imaginary document (the much cheaper, much better Trumpcare plan) was real. He is hardly alone in this. Trump’s lie was merely a less careful version of the same fantasy that Republicans have repeated for eight years. Since the health-care debate began in 2009, they have been promising that if Democrats scrapped their plan, Republicans could provide cheaper, better coverage to the uninsured. Indeed, even as far back as 1994, Republicans promised that if the Clinton health-care plan was defeated, they would start over and pass something terrific instead. They never did. If Obamacare had been defeated in 2010, health-care reform would rank as high on Trump’s agenda today as it did on George W. Bush’s from 2001 to 2008: last. Instead, Republicans are caught having to follow through on their impossible promises. The GOP health-care plan is the teenage nerd’s mythical girlfriend who lives in Canada — the one nobody has ever seen.

Republicans do have ideas on health care. The catch is that those ideas are resoundingly unpopular. They want to force Americans to make do with much cheaper plans that cover much less care. The party has refused to grapple with any of the trade-offs inherent in the issue. Two-thirds of all health spending is consumed by 10 percent of the public. The only way to cover the cost of their care is to make other people pay for it. Republicans denounce any such mechanism. They also denounce Obamacare’s regulations, proposing instead to let anybody buy the kind of insurance they want. But all those regulations serve the purpose of spreading the costs from the sick to the healthy. If healthy people can buy cheaper insurance that doesn’t cover expensive treatments they don’t need, then the cost of those treatments will be borne entirely by people with expensive medical needs. You could fund those treatments through taxes instead — but, of course, Republicans hate taxes even more than they hate regulations.

At his confirmation hearing, Tom Price, Trump’s nominee to run the Department of Health and Human Services, promised, “Our goal would be to go from what we see as a Democrat health-care system to an American health-care system.” He bashed Obamacare for its high deductibles, just as House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell have done repeatedly. But Price’s own plan would feature much higher deductibles than Obamacare, as would most Republican proposals. Price has previously written a plan that would give people a tax credit ranging from $1,200 to $3,000 a year. That’s only enough to pay for about one-third of the cost of an inexpensive individual plan on the market today. He would also let insurers charge higher rates to people with preexisting conditions, unless they manage the difficult task of maintaining continuous coverage. As an article in the New England Journal of Medicine explained, Price’s plan would be “likely to lead low-income and even middle-class healthy people to forgo seeking coverage until a serious health problem develops.” There are alternative Republican plans floating around that provide more-generous coverage, but the catch, as the Washington Post reported, is that “nobody seems to know how to pay for” it.

No wonder Republicans have carefully sequenced their legislative strategy in order to prevent any direct comparison between their ideas and Obamacare. If they believed Trumpcare might compare favorably with Obamacare, they would simply put it to a vote. Instead, their plan calls for separate votes — first to repeal Obamacare and then, in a later vote, to replace it with something terrific. Their only hope of success lies in first destroying the status quo and then using the threat of the disaster they created to somehow put pressure on Democrats, or even recalcitrant Republicans, to vote to put something, anything, in its place.

The party has taken its fastidious secrecy about its health-care intentions to absurd lengths. “In the lead-up to his confirmation hearings, Price has been kept out of the Trump transition team’s efforts to craft an Obamacare replacement plan,” CNN reported. “According to a senior transition official, the incoming administration wants Price to be inoculated from questions about what Trump’s alternative to the Affordable Care Act looks like.” Trump’s advisers would rather delay the process of devising their own plan than risk exposing their ideas to the public.

Republicans certainly aren’t pursuing their repeal-and-delay plan because it’s popular. Various polls have found that 20 percent of the public favors a repeal vote that doesn’t include a replacement plan. They are doing so because, now that they enjoy almost total control of the federal government, they are stuck. Republicans have been catastrophically successful at convincing their supporters that Obamacare is pure evil, devoid of any virtues whatsoever, and thus that it can easily be replaced with an alternative that is superior in every dimension. How far they will go to maintain their lie is a question on which millions of lives now depend.

*This article appears in the January 23, 2017, issue of New York Magazine.

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THE FEED

11:30 a.m.

And yet we keep waiting

As we anticipate the end of Mueller, signs of a wind-down:-SCO prosecutors bringing family into the office for visits-Staff carrying out boxes-Manafort sentenced, top prosecutor leaving-office of 16 attys down to 10-DC US Atty stepping up in cases-grand jury not seen in 2mo

For Boeing and other aircraft manufacturers, the practice of charging to upgrade a standard plane can be lucrative. Top airlines around the world must pay handsomely to have the jets they order fitted with customized add-ons.

Sometimes these optional features involve aesthetics or comfort, like premium seating, fancy lighting or extra bathrooms. But other features involve communication, navigation or safety systems, and are more fundamental to the plane’s operations.

Many airlines, especially low-cost carriers like Indonesia’s Lion Air, have opted not to buy them — and regulators don’t require them. Now, in the wake of the two deadly crashes involving the same jet model, Boeing will make one of those safety features standard as part of a fix to get the planes in the air again.

… Boeing’s optional safety features, in part, could have helped the pilots detect any erroneous readings. One of the optional upgrades, the angle of attack indicator, displays the readings of the two sensors. The other, called a disagree light, is activated if those sensors are at odds with one another.

Boeing will soon update the MCAS software, and will also make the disagree light standard on all new 737 Max planes, according to a person familiar with the changes, who spoke on condition of anonymity because they have not been made public. The angle of attack indicator will remain an option that airlines can buy.

Attorneys for New England Patriots owner Robert Kraft and more than a dozen other defendants charged in a Florida prostitution sting filed a motion to stop the public release of surveillance videos and other evidence taken by police.

Attorneys filed the motion Wednesday in Palm Beach County court. The State of Florida does not agree with the request, according to the filing.

In the motion, the attorneys asked the court to grant a protective order to safeguard the confidentiality of the materials seized from the Orchids of Asia Day Spa in Jupiter, and “in particular the videos, until further order of the court.”

Two years in, White House aides are dismayed to discover the president likes lobbing pointless, nasty attacks at people like George Conway and John McCain

But the saga has left even White House aides accustomed to a president who bucks convention feeling uncomfortable. While the controversies may have pushed aside some bad news, they also trampled on Trump’s Wednesday visit to an army tank manufacturing plant in swing state Ohio.

“For the most part, most people internally don’t want to touch this with a 10-foot pole,” said one former senior White House official. A current senior White House official said White House aides are making an effort “not to discuss it in polite company.” Another current White House official bemoaned the tawdry distraction. “It does not appear to be a great use of our time to talk about George Conway or dead John McCain. … Why are we doing this?

When Mr. Trump was running for president, he promised to personally stop American companies from shutting down factories and moving plants abroad, warning that he would punish them with public backlash and higher taxes. Many companies scrambled to respond to his Twitter attacks, announcing jobs and investments in the United States — several of which never materialized.

But despite Mr. Trump’s efforts to compel companies to build and hire, they appear to be increasingly prioritizing their balance sheets over political backlash.

“I don’t think there’s as much fear,” said Gene Grabowski, who specializes in crisis communications for the public relations firm Kglobal. “At first it was a shock to the system, but now we’ve all adjusted. We take it in stride, and I think that’s what the business community is doing.”

There’s no specific stipulation that Milo must be heard, so it could be worse

President Trump is expected to issue an executive order Thursday directing federal agencies to tie research and education grants made to colleges and universities to more aggressive enforcement of the First Amendment, according to a draft of the order viewed by The Wall Street Journal.

The order instructs agencies including the Departments of Education, Health and Human Services and Defense to ensure that public educational institutions comply with the First Amendment, and that private institutions live up to their own stated free-speech standards.

The order falls short of what some university officials feared would be more sweeping or specific measures; it doesn’t prescribe any specific penalty that would result in schools losing research or other education grants as a result of specific policies.

Tech companies say that it is easier to identify content related to known foreign terrorist organizations such as ISIS and Al Qaeda because of information-sharing with law enforcement and industry-wide efforts, such as the Global Internet Forum to Counter Terrorism, a group formed by YouTube, Facebook, Microsoft, and Twitter in 2017.

On Monday, for example, YouTube said on its Twitter account that it was harder for the company to stop the video of the shootings in Christchurch than to remove copyrighted content or ISIS-related content because YouTube’s tools for content moderation rely on “reference files to work effectively.” Movie studios and record labels provide reference files in advance and, “many violent extremist groups, like ISIS, use common footage and imagery,” YouTube wrote.

The cycle is self-reinforcing: The companies collect more data on what ISIS content looks like based on law enforcement’s myopic and under-inclusive views, and then this skewed data is fed to surveillance systems, Bloch-Wehba says. Meanwhile, consumers don’t have enough visibility in the process to know whether these tools are proportionate to the threat, whether they filter too much content, or whether they discriminate against certain groups, she says.

Two mystery litigants citing privacy concerns are making a last-ditch bid to keep secret some details in a lawsuit stemming from wealthy financier Jeffrey Epstein’s history of paying underage girls for sex.

Just prior to a court-imposed deadline Tuesday, two anonymous individuals surfaced to object to the unsealing of a key lower-court ruling in the case, as well as various submissions by the parties.

Both people filed their complaints in the New York-based 2nd Circuit Court of Appeals, which is overseeing the case. The two people said they could face unwarranted speculation and embarrassment if the court makes public records from the suit, in which Virginia Giuffre, an alleged Epstein victim, accused longtime Epstein friend Ghislaine Maxwell of engaging in sex trafficking by facilitating his sexual encounters with teenage girls. Maxwell has denied the charges.

Rescue teams in Mozambique are struggling to reach the thousands of people stranded on roofs and in trees and urgently need more helicopters and boats as post-cyclone flood waters continue to rise.

Rescue workers, military personnel and volunteers are rushing to save thousands of Mozambicans before flood levels rise further, but with four helicopters, a handful of boats and extremely difficult conditions, have only been able to save about 413 so far.

“I don’t even know if we’ve made a dent. There are just so many people. The scale is huge. We’re busy doing the best we can,” said Travis Trower from Rescue South Africa, adding that a lot of people had been washed away but those still alive, whom he had seen from helicopter flights, were in a very bad state.

More than 400 sq kilometres (150 sq miles) in the region are flooded, according to satellite images taken by the EU, and in some places the water is six metres (19ft) deep. At least 600,000 people are affected, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA), ranging from those whose lives are in immediate danger to those who need other kinds of aid.

About 40 percent of the District’s lower-income neighborhoods experienced gentrification between 2000 and 2013, giving the city the greatest “intensity of gentrification” of any in the country, according to a studyreleased Tuesday by the National Community Reinvestment Coalition.

The District also saw the most African American residents — more than 20,000 — displaced from their neighborhoods during that time, mostly by affluent, white newcomers, researchers said. The District and Philadelphia were most “notable” for displacements of black residents, while Denver and Austin had the most Hispanic residents move. Nationwide, nearly 111,000 African Americans and more than 24,000 Hispanics moved out of gentrifying neighborhoods, the study found.

In an essay accompanying the study, Sabiyha Prince of Empower DC said the city “rolled out the proverbial red carpet” for tens of thousands of new residents in the past five years. But the new dog parks, bike lanes, condominiums and pricey restaurants that followed, she said, are not viewed as improvements by long-term residents, who can feel isolated because of losing neighbors, social networks and local businesses. Prince, an anthropologist, said longtime Washingtonians tell stories of “alienation and vulnerability in the nation’s capital.”